Experts update businesses on antiviral stockpiling

Mar 31, 2009 (CIDRAP News)  Antiviral resistance and the global economic downturn might present new obstacles for corporate antiviral stockpiling, but two medical experts today said the medications are still quick, reliable tools that can help preserve business continuity in an influenza pandemic.

At a webinar today sponsored by the Center for Infectious Disease Research and Policy (CIDRAP) Business Source, an online infectious-disease preparedness resource for businesses, Michael T. Osterholm, PhD, MPH, said experts can't predict if high levels of antiviral resistance recently seen in seasonal influenza A/H1N1 viruses will have any bearing on treatment for a future pandemic strain.

"The honest truth is no one knows," said Osterholm, director of CIDRAP.

However, he told the group that the current level of antiviral resistance won't necessarily persist, as sensitive flu strains might replace resistant ones. Osterholm also pointed out that antiviral resistance hasn't been detected in influenza A/H3N2, a previous pandemic strain that is now a common seasonal strain.

Antiviral medications will still have a vital role to play, given that pandemic vaccine capacity will fall far short of the amount needed for the world population and that little is known about the efficacy of nonpharmaceutical interventions such as social distancing, he said. The drugs will allow employers to provide early treatment for employees who become ill or prophylaxis for workers who are critical to essential business operations.

Osterholm said according to the most recent information, there are 81 million antiviral treatment doses are in the Strategic National Stockpile (SNS) and state stockpiles. About 80% of the supply is oseltamivir (Tamiflu), and 20% is zanamivir (Relenza). Six million courses are to be used to help contain the pandemic outbreak, wherever it occurs in the world. Of the remaining courses, 50 million are in federal reserves and 25 million reside with states.

"It's critical for businesses to understand how your states will use and distribute the antivirals," he said.

Doug Quarry, MBBS, MSc, medical director of International SOS Online, an international provider of medical assistance for travelers and corporate clients, told the group that once businesses factor antivirals into their pandemic plan, a key step is defining a stockpiling goal, which could range from a portion of employees to all employees and their dependents.

"If you were heading down the antiviral path, who are the most important people in your plan?" he asked. "How you work that out might not necessarily be based on seniority."

He described a range of stockpiling options, which include antiviral reservation programs offered by Roche, the maker of Tamiflu, and GlaxoSmithKline, the producer of Relenza. The programs are typically less expensive than buying, rotating, and storing the drugs outright, he said. However, in the chaos of a pandemic, he said the two companies might still have problems distributing the antivirals to their corporate customers.

Other companies offer turnkey solutions, which are online systems that register and educate employees and connect them with physicians who can write antiviral prescriptions, Quarry said. Turnkey systems offer the option of immediate distribution of the antivirals through mail order or pharmacies or traditional stockpiling. He said the limitations include paying for the drugs up front, renewing prescriptions each year, and keeping the stockpile current.

Quarry recommended that companies that have global offices assess the strengths of country pandemic and stockpiling plans, which vary widely. For example, stockpiling is difficult in China because prescriptions are valid for only 2 weeks. However, he added that locations such as Hong Kong and Germany have policies that make it easier for companies to stockpile antivirals.

During a question-and-answer session, some of the viewers said they struggled with shelf-life issues related to stockpiling, particularly during difficult economic conditions. Osterholm acknowledged that businesses and states are hamstrung by strict shelf-life rules, but he said stockpiling is still worth considering.

"There is truly a real benefit for a company to control its own destiny," he said, adding that businesses should be reluctant to dispose of expired antivirals, because shelf-life rules might change in a future emergency.

Osterholm warned viewers against releasing soon-to-expire antivirals for use in treating seasonal flu, because doing so might contribute to antiviral resistance.

Quarry advised businesses to optimize the potency of their stockpiles by regularly reviewing the storage conditions.